Taking a trip is stressful for anyone, let alone someone with chronic obstructive pulmonary disease (COPD). Difficulty breathing can pose a number of problems – from carting around oxygen to dodging allergens and sick travelers. But with the right supplies and precautions, you can still have a “bon voyage”...

When Bonnie Chakravorty travels, she packs items all travelers need, such as tiny toiletries and several changes of clothes and shoes.

But she also totes a few extra ones others don’t: a portable oxygen concentrator, respirator, medications and more.

“It’s a hassle, but not too bad,” says Chakravorty, a public health professor at Tennessee State University. “You have to make [arrangements] ahead of time with the airlines, for instance.”

Traveling can be more challenging for COPD patients because they often must tote supplemental oxygen tanks (filled with compressed oxygen) or concentrators (which concentrate the oxygen found in surrounding air).

And certain destinations can make breathing more difficult, particularly places with poor air quality.

COPD refers to a family of diseases that includes emphysema, a disease that destroys the air sacs in the lungs, and chronic bronchitis (usually defined as lasting more than three months), which leads to inflammation and eventual scarring of the bronchial tubes.

But COPD patients don’t have to be homebound – as long as they seek advice before they travel.

“Most people with COPD, even those who use oxygen, can travel, but should contact their doctor first,” says Norman Edelman, M.D., senior medical advisor to the American Lung Association.

Whether by sea, air or ground, here are some tips for traveling with COPD.

1. See your doctor
Before your trip, discuss travel plans with your doctor to get an honest assessment of your abilities and needs on the road, Dr. Edelman recommends.

2. Get vaccinations
Make sure immunizations are up to date and get a flu shot (influenza vaccine) and pneumococcal conjugate (PCV13) vaccine to protect against pneumonia, suggests Brian W. Carlin, M.D., a pulmonologist and past chairman of the COPD Alliance, which provides clinicians and patients with information about COPD.

“You’re more likely to catch [the flu] when traveling, especially if you’re in a closed compartment in a plane, train or car for a long period,” says Michael Zimring, M.D., director of Travel Medicine at Mercy Medical Center in Baltimore.

COPD patients are also more susceptible to pneumonia, an inflammation of the lungs, which can result in unexpected hospital stays.

3. Check out your equipment
Have your doctor test the equipment, such as compressors and portable oxygen concentrators (POCs), that you’ll be using while traveling, to prevent possible malfunctions and breakdowns.

Also, get a concentrator before your trip to determine if you can handle it on your own or will need assistance to get to the plane, advises Dr. Carlin.

“It can be cumbersome along with your purse and other carry-ons,” Dr. Carlin warns.
Portable, battery-operated concentrators about the size of a laptop and weighing as little as 5 pounds on up to 35 pounds are available, according to the American Association for Respiratory Care. Ask your doctor which type of device is right you: continuous airflow or intermittent airflow; some devices can deliver both.

According to a 2013 study published in the journal Respiratory Medicine, the lighter-weight units run down the battery faster, so you may want to buy extra batteries to bring along.

That’s key if you’re going to a high-altitude place, such as Denver, Rapid City or Las Vegas, because high altitude can trigger shortness of breath, or hypoxemia (low blood oxygen), he says.

The air is thinner and oxygen concentrations are lower at high altitudes, and even COPD patients who don’t use compressors at home may need supplemental oxygen supply in those cities, Dr. Carlin says.

“People think of it when flying, but may not think it’s as significant when they go to a higher altitude,” Dr. Carlin says. “Then, suddenly you’re sleepy and your blood oxygen levels are out of whack.”

At high altitudes, exercise a little lighter than normal or use supplemental oxygen when you exercise, says Dr. Carlin.

5. Prepare for COPD-challenging weather
Check weather reports and avoid smoggy regions or seasons, which are particularly a problem in places like Los Angeles, Pittsburgh and Phoenix.

“Smog is irritating to people with COPD, so maybe you shouldn’t go to those areas in summer,” Dr. Edelman says.

On car trips, use air conditioning and keep windows closed, especially in smoggy conditions and traffic jams, where exhaust can cause lung irritation, Dr. Carlin suggests.

6. Make plans with the airline
COPD patients can’t use their own oxygen compressors (gas in tanks or liquid oxygen) on planes, but airlines allow FAA-approved battery-operated portable oxygen concentrators. Check with the manufacturer of a device to determine whether it has been approved for in-flight use. [Here are 9 more ways to stay healthy on the road.]

To use a concentrator, you must show medical necessity and get permission from the carrier, typically at least 48 hours before your flight.

Rules vary by carrier and are subject to change, so call the airline’s help desk a few weeks before your trip. Ask the airline representative what you need to do to get oxygen aboard the plane, Dr. Carlin advises.

7. Arrive at the airport early
“The worst thing [for COPD patients] is having to rush through a huge, crowded airport,” says Dr. Edelman.

Some carriers require patients with oxygen to check in at least an hour before a flight.

8. Learn the airport security procedures
Your biggest need for oxygen may actually be at the airport, walking around, going through screenings or trying to catch a plane, says Dr. Zimring, author of Healthy Travel: Don’t Travel Without It (Basic Health Publications).

The Transportation Security Agency (TSA) allows supplemental oxygen and other respiratory-related equipment and devices, such as respirators and nebulizers, through airport security checkpoints. Bring a doctor’s note showing medical necessity, just in case.

If you normally use an oxygen compressor, the TSA allows you to stay connected to it until you get to the gate. You’ll have to switch to a concentrator on the plane.

According to the TSA, if you use a portable oxygen concentrator (POC), the manner in which you will be screened depends on whether you can disconnect from the concentrator. You should check with your doctor to determine whether you can safely disconnect during screening.

It’s important that you tell the officer conducting the screening whether you can disconnect before the screening process begins.

If you can disconnect from your POC, the TSA recommends that you check the equipment as checked baggage whenever possible. This way you can be screened using imaging technology or walk-through metal detectors.

If you can’t disconnect, or choose not to be screened by imaging technology or a walk-through metal detector, you will be screened using a pat-down procedure instead.

Also, if you can disconnect during screening but are bringing your POC in your carry-on luggage, the equipment will either undergo X-ray screening or inspection. If your respiratory equipment can’t be X-rayed and an inspection is done, it also will be tested for traces of explosives.

You’ll also need to make arrangements for someone to pick up the compressor equipment from you at the gate. That person will need a gate pass, which also needs to be arranged at least 48 hours in advance through the airline.

The same process applies if you have someone with an oxygen supply meet you at your destination or at a layover airport. Oxygen rules for international carriers vary, so it's extra important to check in advance.
9. Contact the cruise line before sailing
If you are cruising and using supplemental oxygen, tell the cruise company you have COPD at least 4-6 weeks before departure. [And be careful of germs; cruise ships are havens for bacteria and viruses.]

Cruise lines require a letter from your doctor, which should include a brief medical history and a current oxygen prescription.

You’ll have to make advance arrangements to use oxygen tanks and have them delivered to the ship by a medical supplier.

Even if you don’t need supplemental oxygen, have a brief medical history available to show the shipboard doctor if an emergency arises at sea.

10. Make train and bus arrangements before your trip
Amtrak allows portable oxygen equipment (bottled oxygen and concentrators) that doesn’t rely solely on onboard electrical power. But you need to make a reservation and tell the railroad that you plan to use oxygen at least 12 hours before your trip.

Bus companies typically allow use of portable oxygen equipment, but check with the line before your departure. For example, some companies limit the number of canisters allowed onboard.

If you’re traveling internationally, check with the bus or rail line at that destination because policies vary.

11. Map out medical suppliers along your route
Using compressed air tanks? On long car trips, plot places to purchase extra tanks along your route in case you have a malfunction or run out. Your medical supplier may have branches you can visit.

The same applies should you need to purchase additional batteries for a battery-operated portable oxygen concentrator.

12. Avoid COPD triggers in hotels
Triggers for lung irritation are the same on the road as at home.

That’s why you should request non-smoking rooms and floors, Dr. Edelman suggests. Even third-hand smoke can be irritating to the lungs, he says.

If allergens are a COPD trigger, request an “allergen-free” room, which some hotel chains, such as Hilton, offer. It means extra steps have been taken to reduce dust and other allergens, such as wood flooring, shades and hypoallergenic linens.

As of early 2014, most cruise ships have banned smoking in all cabins, though some lines still allow smoking on cabin balconies. Check with the cruise line about their policies.

13. Pack essentials
Whether traveling by plane, boat, car, bus or train, experts advise that you take these items:

Extra supplies of your medications in case you get delayed or stranded

Copies of all prescriptions in case you need a refill or luggage is lost. Put it in your carry-on luggage

Names of local doctors or hospitals at your destination where you can seek help if needed. Also include a list of phone numbers for your insurance company and health-care providers (e.g., doctor and respiratory therapist)

A written note from your doctor detailing your medication and oxygen needs with a brief description of your condition. You may need this at the airport if you’re taking an oxygen concentrator

All medications, including inhalers, nebulizers or bronchodilators, in your carry-on in case of delays or lost luggage

Hand sanitizer, either wipes or gel (3.4 ounces or less to meet TSA requirements), in your carry-on. If you’re in an airplane there are probably going to be some people who are sick, and someone may cough and touch things you will touch, such as the bathroom door handle, Dr. Carlin says. “Be aware of that and wash your hands.”

14. Stay home if you’re sick
It’s a good rule for all travelers, “but COPD patients should think twice about” traveling when sick, Dr. Carlin advises.

That’s because people with COPD are more susceptible to respiratory infections.

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